Revitalizing Kidney Yang And Resolving Chronic Prostatitis: A TCM Surgical Perspective Featuring Cistanche

2. Applying the "Tu Method" to Treat Chronic Prostatitis: A TCM Surgical Perspective Based on the "Internal Abscess" Theory

In Traditional Chinese Medicine (TCM), the Tu Method (托法) is a unique internal therapeutic strategy originally developed by external medicine. It emphasizes supporting the body's righteous qi (zheng qi) while promoting the discharge of toxins and pus, thereby preventing the inward spread and entrenchment of pathogenic factors. Its earliest mention can be traced to Liu Juanzi's Ghost Prescriptions (刘涓子鬼遗方).

In treating suppurative conditions like abscesses, internal therapy takes precedence, with the Tu Method at its core. As stated in Essence of External Medicine (外科精义): "No abscess physician should be without Tu-supporting prescriptions for even a single day." The Tu Method serves as a bridge between draining (Xiao) and tonifying (Bu) approaches-typically categorized into supportive (Bu-Tuo) and purgative (Tou-Tuo) strategies.

Once an abscess forms, with intense toxin accumulation and a stalemate between pathogenic and righteous qi, the Tu Method aims to regulate this dynamic. As Liu Hejian noted in Collection of Essential Theories on Pathomechanisms and Qi (Su Wen Bing Ji Qi Yi Bao Ming Ji): "The essence of abscess treatment lies in Tu-support, drainage, and harmonizing ying and wei qi." This underscores the core function of Tu-providing a pathway for toxins to exit, thereby avoiding internal aggravation.

Based on the chronic and recurrent nature of chronic prostatitis (CP), Professor Wang Wanchun believes the Tu Method provides a useful framework: early-stage CP should be treated by purgative Tu to manage excess, while long-standing cases require supportive Tu to replenish deficiency.

 

2.1 Early-Stage CP: Predominance of Excess – Using Purgative Tu to Address Symptoms

Professor Wang observes that early-stage CP is often linked to diet, lifestyle, and environmental factors:

Dietary irregularities or excessive intake of greasy, fatty foods impair spleen function, leading to internal damp-heat.

Poor sleep hygiene, emotional stress, and overwork impair kidney essence and metabolic balance.

Living in hot, humid climates increases susceptibility to damp-heat invading the lower burner (xiajiao).

These factors result in damp-heat stagnation in the pelvic region, manifesting as lower abdominal pain, urinary urgency and frequency, incomplete urination, etc. At this stage, zheng qi remains relatively intact, making it suitable to "expel the pathogen before it consolidates".

Professor Wang favors "Tou Nong San (Pus-Expelling Powder)", a classical Tu-based prescription consisting of Cistanche, Angelica (Dang Gui), Chuanxiong, Pangolin Scales (substituted now with Vaccaria or Turtle Shell due to conservation laws), and Gleditsia Spines (Zao Jiao Ci).

 

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This formula is primarily purgative with secondary support:

Huang Qi strongly tonifies qi and expels toxins-serving as the chief herb.

Dang Gui and Chuanxiong nourish and activate blood-functioning as deputies.

Vaccaria, Gleditsia Spines, and a small amount of alcohol act as assistants to enhance circulation and promote toxin discharge.

Compared to antibiotics, this formula not only accelerates pus maturation and discharge but can also localize inflammation, facilitating resolution or absorption in milder cases.

Professor Wang frequently combines Gleditsia Spines with herbs for:

Qi-regulation and purgation: Chen Pi, E Zhu

Aromatic dispersal: Bai Zhi, Jie Geng

Heat-clearing and detoxification: Pu Gong Ying, Lian Qiao, Tian Hua Fen

Dampness-draining: Yi Yi Ren, Dong Gua Ren

Abscess reduction: Zhe Bei Mu, Sheng Mu Li

Modern pharmacology confirms Gleditsia Spines contain bioactive compounds with anti-inflammatory, antimicrobial, antitumor, and immune-modulating properties.

 

2.2 Chronic CP: Deficiency Syndrome – Using Supportive Tu to Treat the Root

Citing Ye Tianshi's principle in Clinical Case Records: "Chronic disease inevitably affects the kidneys", Professor Wang emphasizes that chronic prostatitis is not confined to the genitourinary system but reflects systemic organ imbalance.

Kidney deficiency leads to bladder dysfunction, manifesting as urinary frequency and urgency.

Kidney yin or yang deficiency can cause erectile dysfunction, premature ejaculation, and cold limbs.

Spleen-kidney disharmony further exacerbates fatigue, seminal leakage, and damp accumulation.

Liver qi stagnation, often due to emotional stress, contributes to pain, depression, and sexual dysfunction.

Thus, chronic CP requires a multi-organ, whole-body approach, avoiding overuse of purgative Tu in deficiency states. Instead, supportive Tu becomes the foundation, harmonizing the kidney, spleen, liver, and bladder as a functional unit.

Professor Wang often prescribes Tuo Li Xiao Du San (Support and Detox Powder) in later stages, modifying it based on patient constitution. The core herbs include:

Cistanche, Codonopsis, Atractylodes, Ginseng – to tonify qi and support toxin expulsion.

For kidney yin deficiency, he modifies Nei Bu Huang Qi Tang (Internal Supplementing Cistanche Decoction) with Rehmannia, Ligustrum, Cornus, etc.

Originally from the Song Dynasty, Tuo Li Xiao Du San was refined during the Ming era (Wai Ke Zheng Zong), and is now used for chronic abscesses in deficient patients. Its components:

Cistanche and Ginseng – replenish qi and promote healing

Angelica, Chuanxiong, White Peony – nourish and activate blood

Atractylodes, Poria – strengthen spleen, drain dampness

Jin Yin Hua, Bai Zhi, Jie Geng – clear heat and promote toxin discharge

Gleditsia Spines – guide herbs to the lesion site

Licorice – harmonize the formula

Modern studies show this prescription can inhibit NF-κB signaling and NLRP3 inflammasome activation, demonstrating anti-inflammatory and immunomodulating effects.

Nei Bu Huang Qi Tang, developed by Xue Liji during the Ming Dynasty, is used for non-healing abscesses in deficient patients, enhancing qi, blood, and tissue regeneration. Herbs include:

Cistanche, Ginseng, Ophiopogon (Mai Dong), Polygala (Yuan Zhi) – to tonify qi and calm the mind

Rehmannia, Poria, White Peony – to nourish yin and soothe liver

Angelica, Chuanxiong, Cinnamon – to warm channels and invigorate blood

Motherwort, Licorice – for detoxification and harmonization

Professor Wang uses this formula in late-stage CP with kidney essence depletion and blood deficiency, adding herbs like Vinegar-Chai Hu, Rose Flower for liver qi stagnation, and Licorice to prevent heat accumulation during long-term illness.

 

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3. Case Study

Patient: Mr. He, 34, bank employee.
Date: February 24, 2024
Symptoms: Frequent urination, urgency, post-void dribbling, perineal heaviness, nocturia (6–8x/night), poor sleep.
Diagnosis:

Western Medicine: Chronic Prostatitis

TCM: Jing Zhuo (精浊), Damp-Heat with Blood Stasis

Treatment Principle: Clear heat, drain dampness, remove toxins, resolve stasis.

Prescription (14 doses):

Vinegar-Chai Hu, Chi Shao, Dan Shen, Fu Ling, Zhu Ling, Lu Lu Tong, Wang Bu Liu Xing, Litchi Kernel, Salt Citrus Kernel, Gleditsia Spines, Bai Zhi, Lian Qiao, Zhi Gan Cao

Second Visit (March 9): Symptoms improved, nocturia reduced to 5–6x. Added Fu Shen to calm the mind.

Third Visit (March 23): Further improvement, now experiencing erectile dysfunction and cold limbs (kidney yang deficiency). Switched to supportive Tu formula with:

Huang Qi, Dang Shen, Fu Ling, Bai Zhu, Salt Cuscuta, Goji Berry, Salt Eucommia, Wine-Duan Xu, Shan Yao, Wang Bu Liu Xing (to guide herbs downward), Motherwort, Zhi Gan Cao

Outcome: After 10 more doses, symptoms significantly improved. Patient continued treatment for consolidation and reported good prognosis.

Commentary: The patient's constitution and lifestyle (sedentary, fatty diet) contributed to internal damp-heat and stagnation. The treatment followed internal abscess theory, using Tu Method throughout-purgative Tu in early stage, supportive Tu in late stage, achieving detoxification without harming healthy qi, and tonification without retention of pathogens.

4. Conclusion

Chronic prostatitis is a complex, multifactorial condition prone to external triggers and long-lasting symptoms. While Western medicine offers rapid symptomatic relief, TCM provides a complementary advantage in long-term management and relapse prevention.

With the integration of modern diagnostics and pathophysiological insights, TCM's understanding of CP continues to evolve. Professor Wang Wanchun's approach, rooted in "internal abscess" theory, and refined through "Tu Method", bridges classical wisdom and modern clinical practice.

However, clinical application of the Tu Method must be based on careful syndrome differentiation. Premature use of tonifying Tu in the presence of unresolved pathogenic factors may lead to retention and worsening of the disease. Moreover, Tu should not be narrowly interpreted as merely promoting pus formation; rather, it should facilitate the body's adaptive response, guiding internal qi and blood through the meridians, from deep to superficial, and from within to without-ultimately resolving obstruction and restoring systemic harmony.